Elsevier

Journal of Surgical Education

Volume 66, Issue 2, March–April 2009, Pages 85-88
Journal of Surgical Education

Original report
Impact of the 80-hour Workweek on Surgical Exposure and National In-Training Examination Scores in an Orthopedic Residency Program

https://doi.org/10.1016/j.jsurg.2008.12.007Get rights and content

Objectives

This study examines the impact of the 80-hour workweek on the number of surgical cases performed by PGY-2 through PGY-5 orthopedic residents. We also evaluated orthopedic in-training examination (OITE) scores during the same time period.

Methods

Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) national database for 3 academic years before and 5 years after July 1, 2003. CPT surgical procedure codes logged by all residents 3 years before and 5 years after implementation of the 80-hour workweek were compared. The average raw OITE scores for each class obtained during the same time period were also evaluated. Data were reported as the mean ± standard deviation (SD), and group means were compared using independent t-tests.

Results

No statistical difference was noted in the number of surgical procedure codes logged before or after the institution of the 80-hour week during any single year of training. However, an increase in the number of CPT codes logged in the PGY-3 years after 2003 did approach significance (457.7 vs 551.9, p = 0.057). Overall, the average number of cases performed per resident increased each year after implementation of the work-hour restriction (464.4 vs 515.5 cases). No statistically significant difference was noted in the raw OITE scores before or after work-hour restrictions for our residents or nationally.

Conclusions

We found no statistical difference for each residency class in the average number of cases performed or OITE scores, although the total number of cases performed has increased after implementation of the work-hour restrictions. We also found no statistical difference in the national OITE scores. Our data suggest that the impact of the 80-hour workweek has not had a detrimental effect on these 2 resident training measurements.

Introduction

Residency programs across the country have undergone restructuring because of the recent guidelines put forth by the Accreditation Council for Graduate Medical Education (ACGME) in 2003.1 Guidelines specify that a resident may not work greater than 80 hours a week averaged over a 4-week period, no new patient contact is allowed after 24 hours on duty, a work day cannot be greater than 30 consecutive hours, and a resident must have off 10 hours between call and returning to work.1, 2 Because of the work-hour regulations, surgical and nonsurgical programs around the country have instituted innovative solutions to accommodate the changes, which include hiring physician extenders, using at-home call, establishing surgical skills laboratories, and developing a night float system.3, 4 Recent articles have discussed several aspects of the impact of work-hour restrictions on patient mortality, resident family birth rates, and resident perception of quality of life.5, 6, 7 Limited data discussing the specific impact of the work-hour restrictions on orthopedic surgical training and knowledge are available.

In this article, we evaluate the impact of the new work-hour regulations on the surgical exposure and educational development of residents in a single 3-resident-per-year orthopedic program. To evaluate surgical exposure specifically, we collected logged CPT codes in the ACGME data bank for PGY-2 through PGY-5 residents from 2000 to 2008. To evaluate educational development, we examined raw orthopedic in-training examination (OITE) scores of PGY-2 through PGY-5 residents 3 years before and 5 years after the work-hour mandate. For reference in this article, a PGY-2 designated year is the first year of orthopedics after completion of a general surgery intern year.

Section snippets

Materials and Methods

ACGME resident case logs were used from a single orthopedic residency program, which featured volunteer, private, and full-time academic faculty. Data were collected for 3 academic years before and 5 years after the initiation of work-hour regulations on July 1, 2003. All residents in training PGY-2 through PGY-5 were included. PGY-1 residents were excluded because they were not required to log CPT codes with the ACGME, and therefore, reporting would not be consistent. During evaluation of OITE

Results

Thirty-five individual resident years before 2003 and 62 resident years after 2003 were available for analysis. The average number of cases performed per year before 2003 was 464.4 compared with 515.5, with a net gain of 51.2 procedures after 2003. The average number of cases performed before the work-hour restrictions was 480.1 for PGY-2s, 457.7 for PGY-3s, 499.6 for PGY-4s, and 424 for PGY-5s. After implementation of the 80-hour workweek, the average number of cases performed was 541.8,

Discussion

This study was undertaken to assess the impact of the 80-hour workweek on a single orthopedic residency program. Since discussion first began of work-hour reform, both residents and attendings showed concern that surgical resident training would be negatively impacted because of work-hour restrictions.3 We found no evidence of decreased surgical exposure in our residency program based on the specific criteria of logged CPT codes. Contrary to anticipated results, the number of procedures

References (10)

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